Allied Health Scientific and Technical Professionals - Showcasing Innovation

Allied Health Scientific and Technical Professionals Showcasing Innovation

Contents Patient Oriented Care Delivery

2

Establishment of Physiotherapy and Social Work Service Nelson Marlborough District Health Board

By Debbie Hollebon, Clare Holmes, Alice Scranney & Tom Morton

6

Community Pharmacy Anticoagulation Monitoring Service Canterbury District Health Board

By Kevin Taylor

8

Dietitians Single Point of Request Canterbury District Health Board

By Sally Watson

10

A Vision of Shared Care Southern District Health Board

By Annie Sutherland and Noelle Bennett

14

Extended Scope Practitioner Counties Manukau District Health Board

By Corey Rosser

Service Focused

18

Straight Up - Young People Talk About Alcohol Project Whanganui District Health Board

By Sacha Harwood and Melissa Wishart

20

Senior Chef - Cooking Classes for Older People Canterbury District Health Board

By Sally Watson

24

Tracheostomy Review and Management Service Capital and Coast District Health Board

By Kerry Huggins and Molly Kallesen

28

Occupational Therapy Role on the Acute Orthopaedic Ward Capital and Coast District Health Board

By Jess Thompson

32

Enhanced Recovery After Surgery (ERAS) in Orthopaedics Taranaki District Health Board

By Greg Sheffield

34

Pharmacist Prescriber Counties Manukau District Health Board

By Gemma Stanbridge

36

Paediatric Multimedia Project Canterbury District Health Board

By Kate Parker

Educational Focus

42

Allied Health Technical and Scientific Educator Capital and Coast District Health Board

By Suzanne Stubbs

48

Sonography Training Counties Manukau District Health Board

By Gemma Stanbridge

Directors of Allied Health, Scientific & Technical Professions ‘Showcasing Innovation’ The roles of AHS&T workforces are fundamental to delivering all clinical services across the health sector, both primary (community) and secondary (hospital) care and this website is where you can find out why.

The Directors of Allied Health, Scientific and Technical (DAHs) have joined up with Waikato Institute of Technology (WINTEC) and Christchurch Polytechnic Institute of Technology (CPIT) to produce a dynamic collection of Allied Health, Scientific and Technical (AHS&T) innovations to be launched at the Allied Health, Scientific and Technical Conference in 2014.

In this magazine we showcase and share the exciting initiatives happening in the AHS&T world and beyond and with the help and imagination of the Students at WINTEC and CPIT, through the 2013 academic year, they have been brought to life through the many multi media applications available.

This has been a great, joint opportunity for both the health sector (DHBs), the health professions (AHS&T), the tertiary sector (WINTEC and CPIT) and the potential upcoming workforce (students).

Acknowledgements

We thank and acknowledge each of the teams from District Health Boards (DHBs) that have contributed their initiatives for inclusion in this ‘allied health, scientific and technical professions showcasing innovation’ project.

We thank them for giving time in their busy schedules, bringing their expertise and enthusiasm to this project.

We also wish to thank and acknowledge the students and tutors, at the School of Media Arts, WINTEC and Creative Industries, CPIT for their significant contribution to the design and delivery of this project.

It has been a great joint effort delivering an excellent and exciting finished product.

Directors of Allied Health, April 2014

Acknowledgements

Capital & Coast District Health Board

Counties Manukau Health Counties Manukau District Health Board (CMDHB) was

Capital & Coast District Health Board has two distinct

established on 1 January 2001 under the provisions of

roles. The Directorate of Planning and Funding Service

the New Zealand Public Health & Disability Act 2000.

(P&F) is responsible for assessing the health needs of

CMDHB is responsible for the funding of health and

the people of the district, and contracting the most

disability services and for the provision of hospital and

appropriate services to meet those needs. Hospital

related services for the people of Counties Manukau

and Health Services (HHS) is responsible for providing

(Manukau City, and Franklin and Papakura Districts) as

secondary services via the hospital and community

set out in the DHB functions and objectives in the Act.

outreach programmes. CCDHB operates two hospitals – Wellington and Kenepuru and as well as the Kapiti Health Centre at Paraparaumu. There are also a number of community bases.

Nelson Marlborough District Health Board Nelson Marlborough DHB’s over-arching vision is

Canterbury District Health Board

‘Leading The Way to Health Conscious Families’. That means both providing a range of health services and

Canterbury District Health Board is the main planner

also encouraging us all to build and maintain healthy

and funder of health services in Canterbury; Canterbury

lifestyles. NMDHB’s Mission Statement - ”To work with

DHB is also a tertiary provider of hospital and specialist

the people of our community to promote, encourage

services – both for the Canterbury population and

and enable their health, wellbeing and independence”.

also for the populations of other DHBs where more specialised services are unavailable; We are a promoter of our population’s health and wellbeing; and the largest

Southern District Health Board

employer in the South Island, employing over 9,000

Southern DHB has a staff of approximately 4,500 and is

people across our services.

governed by a Board made up of both publicly elected and government appointed members. The Board is accountable to the Minister of Health. As a DHB, we are responsible for planning, funding and providing health and disability services to a population of over 304,268 located South of the Waitaki River. Our catchment area encompasses Invercargill City, Queenstown – Lakes District, Gore, rural Southland, Clutha, Central Otago, Maniototo, Waitaki District and Dunedin City.

Taranaki District Health Board

Wintec

Taranaki District Health Board is a Crown entity

Waikato Institute of Technology (Wintec) is one of New

responsible for the provision and funding of health and

Zealand’s largest technology institutes and is a leading

disability services in the region. The board governs all

provider of high quality, vocational and professional

Taranaki public hospitals, community services, including

education in the Waikato region. With three campuses

district nursing, health education and public health,

throughout the region Wintec has been serving the

such as health promotion and protection. It will soon

Waikato for over 80 years. The Wintec team have

be responsible for many private services, such as GPs,

provided invaluable support to the AHSTC Committee

private rest homes and other health service providers,

and conference.

who have previously contracted with a Government agency (HFA) for services.

Whanganui District Health Board

CPIT Christchurch Polytechnic Institute of Technology is an inspiring place that changes lives. We support and empower people to succeed because we know that

Our vision is to provide ‘Better health and

when an individual succeeds, the whole community

independence’ with our mission being ‘to improve

benefits. The CPIT experience is all about learning,

health and independence through a responsive and

respect, innovation, connection and success. When

integrated health system’. All Whanganui District Health

you engage with us, you contribute to our community

Board endeavours are be guided by the following set

and gain from the experience. We have some of the

of values: Co-operation, Social equality, Adaptability,

most talented teachers and staff, innovative business

Development, Integrity, Responsibility, and Respect.

collaborators and supportive community partners around. All are passionate about the role they play in our students’ success.

Patient Oriented Care Delivery

Establishment of Physiotherapy and Social Work Service Community Pharmacy Anticoagulation Monitoring Service Dietitians Single Point of Request A Vision of Shared Care Extended Scope Practitioner

1

Establishment of Physiotherapy and Social Work Service Within Nelson Hospital Emergency Department

Nelson Marlborough District Health Board Article by Debbie Hollebon, Clare Holmes, Alice Scranney & Tom Morton

N

elson Emergency Department (ED) serves a catchment of

would be delivered Monday to Friday between 8 am to 5 pm. However,

approximately 90,000 people in the Nelson and Tasman

over the pilot both weekend and public holiday working would be trialled.

Region. In 2011, a strategic meeting was held, to discuss future models of care to address the increasing demands

The project commenced in early 2012, with established key

at the interface between primary care and the emergency

performance indicators, robust data collection and an agreed

department. A number of potential solutions were proposed and

evaluation framework including both quantitative and qualitative data.

an immediate step forward was to consider how Allied Health team

During the 22 weeks of the pilot a total of 749 patients received allied

members could be placed within ED to better coordinate responses to

services, representing 57% physiotherapy and 43% social work; this

optimise the patient journeys.

represented approximately 7% of the ED presentations over the 22 weeks. Of the total contacts for the 749 patients, a further 332 follow

The Director of Allied Health and the Clinical Director of the Emergency

up appointments were made by social work. Further demographic

Department became the sponsors of the project and established

breakdown identified 56% of patients were female and 44% male; 9%

a working group between allied health, medical, nursing and key

identified as Maori and this is significant as in the Nelson region only

stakeholders to ensure a robust quality, safety and clinical

9% identify as Maori, as reported in the Statistics New Zealand 2006

governance framework.

Census. All age ranges were represented, however the over 65 year olds received the highest intervention rate, followed by 17 – 44 year old

A six month project to deliver both physiotherapy and social

age group and equally 0 – 16 and 45-64 year old groups.

work service was implemented with the aim that the Allied Health practitioners would work as part of the multi-disciplinary team, utilizing

In relation to physiotherapy, the majority of referrals were for musculo-

their unique knowledge and skills to assess patients physical, mobility,

skeletal injuries across all age ranges, with lower limb injuries and falls

rehabilitation, support, and psychosocial needs and advocate for

being the predominate presentation; primary contact intervention was

patients. Linkages to other allied health services and the coordination

provided to 120 patients.

of discharge planning back to the primary care sector would also be a focus.

Social work services related predominantly to the assessment and provision of home care support, followed by support to children and

Unique to the pilot was the establishment of primary physiotherapy

families experience a wide range of different needs such as financial

contact, which involved patients being identified, assessed and

assistance and domestic violence.

treated by the physiotherapist directly from the initial presentation and triage. Strict criteria applied and this related only to those patients

A consumer questionnaire indicated 86% of responders rated the

with musculo-skeletal conditions triaged at level 4 and 5. The service

service extremely helpful. Common themes included the benefits of

supported the Ministry of Health ED targets, to provide ‘Better More

receiving information, treatment, practical support, follow-up advice

Convenient Services’, and ensure the right service is delivered at the

and support into the community from the allied health staff. All ED staff

right time by the most appropriate health professional. The service

reported both social work and physiotherapy extremely helpful. The

2

common themes reported were the freeing of medical and nursing staff time to concentrate on triage 1, 2, 3 patients, the positive impact on the quality of patient care, support for young doctors, MDT working, assistance with new GP enrolments, screening for falls in over 65 year-olds, coordinated discharge planning, and addressing frequent presenters to ED. DHB and community stakeholder feedback reported improved communication across the hospital and community, admissions to hospital were avoided, families were more supported and empowered, there were positive linkages to private providers, a reduction in hospital based acute allied health staff being called to ED and the early identification of rehabilitation patients i.e. stroke.

During the pilot it was identified that 66 patients avoided admission to hospital, which along with the primary contact physiotherapy resulted in the cost benefits exceeding the personnel costs associated with the pilot, providing the DHB with financial savings. These savings, along with the experience of care for the patients being enhanced, interventions targeted, nursing and medical staff time freed and patients connected to primary and community services clearly demonstrated that the pilot had achieved its objectives. Following the success of the pilot, the Executive Leadership of the DHB endorsed the continuation of the allied health

A physiotherapist offers advice to an injured woman who has come to the Emergency Department.

service in Nelson ED from December 2012.

The following were the team that rolled out the Pilot: Hilary Exton, Director Allied Health; Tom Morton, ED Clinical Director; Jan Mitchell, ED Charge Nurse Manager; Deidre Crichton, Physiotherapy Team Leader; Social Work District Team Leader; Alice Scranney and Clare Holmes, Physiotherapists and Debbie Hollebon, Social Worker.

3 Part of the team that rolled out the pilot for this project.

Emergency Department physiotherapists and social worker

“

Allied Health practitioners would work as part of the multidisciplinary team, utilizing their unique knowledge and skills to assess patients physical, mobility, rehabilitation, support, and psychosocial needs and advocate for patients.

�

4

5 Head of Emergency Department

Anticoagulation Monitor.

Taking a reading from the Anticoagulation Monitor (below).

6

Community Pharmacy Anticoagulation Monitoring Service A Multi-disciplinary Approach Canterbury District Health Board Article by Kevin Taylor

T

he Community Pharmacy Anticoagulation

Pharmacy and the Laboratory. The results would then be

Monitoring Service (CPAMS) programme is

checked to ensure they matched.

not unique to Canterbury as it is a nationwide initiative, however the collaboration between the

Following the initial set up of the quality control process at

Canterbury DHB Planning and Funding department,

the Pharmacies, as with the GP clinic service, an evaluation

Pharmacies and Canterbury Health Laboratories (CHL) is. All

of the process was carried out. The results of the evaluation

three services are working collaboratively to ensure accurate

showed that the service was working well. The ongoing

results for enhanced patient safety through a rigorous

performance of the Pharmacies is continually monitored

quality control system. This includes regular comparisons

using this process.

between results being obtained in the pharmacies and those obtained in the laboratory, participation in an Australasian

The CPAMS programme is more sustainable as the

wide external quality control programme and continual

appropriate support networks are in place locally to

competency assessment of staff.

ensure ongoing training and competency of the staff at the Pharmacies and, therefore, ensuring the key goal of

Canterbury Health Laboratories has vast experience in point

patient safety.

of care (POC) international normalised ratio (INR) monitoring through implementation of a community warfarin monitoring

The benefits to the patients who require warfarin is that

service within rural and urban GP clinics. Canterbury Health

the testing required is now much less intrusive, it is now a

Laboratories has a passion for quality and patient safety and

simple finger prick test with results available immediately,

identified some scope to support community pharmacies

rather than a blood test (venesection in the arm) with results

with additional training and quality assurance not in place

taking approximately six hours. With this enhanced access

for the national initiative.

to warfarin monitoring it enables the accurate timely dosage of medication to be provided to patients.

Canterbury DHB Planning and Funding department and CHL worked collaboratively to develop a workable system for

The cost of testing itself is slightly higher than traditional

enhanced quality control, in line with the current protocols

methods but the time savings following up patient results for

in use at the GP clinics. New solutions were implemented

nursing and medical staff are substantial. Improvement of

to meet the unique situation of the Pharmacies. As blood

patient Warfarin levels within therapeutic range results is a

testing was a new service for the Pharmacies, to check

direct saving to the health system through reduced Emergency

the accuracy of the test results being provided by them, a

Department admissions from bleeding and clotting events in

mobile phlebotomist from CHL would visit to take blood

patients whose warfarin dose control is not maintained.

from patients and have the blood tested by both the

7

Dietitians Single Point of Request Canterbury District Health Board Article by Sally Watson

A

s part of the Canterbury District Health Boards

In mid-2012 a single point of request (SPOR) was developed

“whole of system” improvement initiative dietitians

with HealthPathways, a web-based patient management

in Canterbury have developed a new simplified

system, and the DSP.

process for general practice to request

This included:

publicly funded dietitian services. The previous

1. DSP jointly agreeing criteria and wait times;

process involved general practice sending requests to

2. establishing a simplified request process; and

individual dietitian service providers (DSPs). This process

3. a new pathway outlining access criteria, exclusions,

was confusing and complicated for general practice and

request process and wait times.

inefficient for DSPs. Considerable time was being spent by each DSP returning requests to general practice and/

At the end of 2012 the Dietitians SPOR was launched on

or re-directing requests to other DSPs. General practice

HealthPathways and promoted to general practice.

had to decide between ten different DSPs, each with their own access criteria and request process. The majority of

The new process includes the following significant changes:

access criteria were incomplete and/or ambiguous. To send

• A new pathway outlining access criteria, exclusions,

a request via the Electronic Request Management System

request process and wait times on HealthPathways.

(ERMS) was not an option at this point.

• Option to send requests via the ERMS or fax. A simplified faxed request form covering both adult and paediatric requests is available on the pathway.

• Requests triaged by a dietitian against clear access criteria. Accepted requests are sent to the appropriate DSP. Declined requests are returned to the general

8

practice with reason for decline and the next best

an increased profile of dietitian services and access

option for the patient. This is usually to consider referral

criteria. Informal feedback from general practice has

to a private dietitian and/or community nutrition and

also been positive. Formal feedback will be sought after

physical activity programmes.

12 months of operation.

• The pathway includes a list of exclusions which are linked to relevant management pathways,

Request data at the Dietitians SPOR is collated into

written patient information and contact details for

quarterly reports and enables unmet need across dietetic

private DSPs.

services in Canterbury to be identified and quantified.

• A new email address, specifically for general practice

Currently the largest unmet need for both adults and

was set up to direct enquiries about access criteria,

children is dietary advice for weight loss. To address

exclusions and the request process.

unmet need the Canterbury District Health Board is supporting a whole of system approach to reviewing

In August 2013 feedback on the new process was sought

dietitian services which will be undertaken in 2014.

from DSPs. Feedback was very positive and benefits reported included an improvement in quality of requests, reduced dietetic time triaging and declining requests, plus

9

A Vision of Shared Care Radiation Therapist-Led Patient On-Treatment Review Clinics for the Management of Radiation-Induced Toxicities Southern District Health Board Article by Annie Sutherland and Noelle Bennett

A

s radiation therapy techniques become increasingly

most extreme but nonetheless fairly common toxicity,

complex and practice focuses on the greater good

severely affects patient comfort levels as well as their

of the patient, some crossing of professional

psychological well-being. It also poses the risk of infection

boundaries will occur. In a first for New Zealand,

in patients who, due to their condition and treatment, are

we instigated radiation therapist (RT) led on-treatment

immuno-compromised. In extreme cases extensive moist

review clinics for breast cancer patients which saw us step

desquamation may result in a treatment break, which could

into an area that is traditionally considered the domain of

compromise local control and, ultimately, patient outcome.

medics. Following on from this came clinical trials, initiated and managed by RTs, aimed at providing the authentication

Our overarching aim therefore has been to investigate

for our emerging evidence-based practice.

whether we could find a treatment that would be superior

One set of trials in particular had significant ramifications for

to the current “standard” of aqueous cream in that it would

our practice.

actually reduce the incidence and extent of radiation induced moist desquamation in breast cancer patients.

Breast cancer is the most common malignancy for women in New Zealand and the majority will receive radiation

We began our quest by running two successive clinical

therapy as part of their treatment regimen. Despite the

trials – the first one in Dunedin alone followed by a second

fact that severe acute radiation-induced skin toxicities will

multicentre one across four of the eight departments in New

occur in a significant proportion of patients (men get breast

Zealand (including Dunedin). These randomised controlled

cancer too!) there is no evidence-based standard treatment

trials compared the efficacy of a silicon foam dressing

for these reactions – in fact treatments aimed at trying to

(Mepilex Lite) with the standard treatment of aqueous cream

reduce these toxicities can vary not only between but also

on the severity of acute radiation-induced skin reactions.

within institutions worldwide.

Mepilex Lite is an absorbent, self-adhesive dressing consisting of a thin flexible sheet of absorbent hydrophilic

Treatment tends to be based on historical and anecdotal

polyurethane foam bonded to a water vapour-permeable

evidence with many departments – including ours – opting

polyurethane film backing layer. The contact surface of the

for the use of aqueous cream in spite of a large randomised

dressing is coated with a soft silicone adhesive layer without

controlled clinical trial (n=357) showing that aqueous cream

any added chemicals, based on the patented Safetac

neither prevents nor decreases the severity of skin reactions.

technology. It adheres to healthy skin thus keeping the

Radiation-induced moist desquamation (MD), the

dressing in position but does not cause trauma on removal.

10

Creaters of the project, Annie Sutherland and Noelle Bennett.

The material does not react with chemicals in or on the

very small bolus effect, generally they had to be removed

skin, does not react with radiation, does not stick to open

before radiation treatment was given because they covered

wounds and can be left on the skin for several days.

up the tattoos that are required for daily patient set-up.

A total of 104 patients were enrolled across the two trials,

Secondly, the dressings did not stick well around compound

each receiving 50Gy in 25 fractions or biologically

curves – such “awkward” places as underneath the breast

equivalent dose.

(inframammary fold) or in the axilla – the very areas that were prime candidates for developing moist desquamation. Whilst

Toxicities were assessed three times a week using the

the results were generally pleasing they did indicate that

Radiation-Induced Skin Reaction Scale (RISRAS) with

the incidence of moist desquamation was not significantly reduced (47% in the

patients doubling as their own controls to eliminate confounding

“Importantly from our perspective, the

axilla, 67% in the infra-

patient and treatment related

Film conforms to compound curves

mammary fold).

factors. The dressings were applied only after the first skin reactions,

thus potentially offering the ultimate in

We determined that we

in the form of faint erythema, were

protection to the infra-mammary fold and

wanted to succeed in

noted. The trial endpoint was moist

axilla – in fact patients have commented

decreasing the extent

desquamation (MD). The radiation dose received by the Mepilex and aqueous cream treated skin areas

that the Film is so comfortable they forget it is there.”

of moist desquamation in the axilla and the inframammary fold by 20% or more from the

was measured using thermoluminescence dosimeters (TLDs) in order to verify that

level the previous trials had shown. As radiation-induced

any difference in reaction between the two areas was not

skin reactions are so common in this patient cohort, from a

attributable to dose differences.

purely philanthropic standpoint any new treatment option that has the potential to minimise further distress to women

Statistical analysis clearly demonstrated a significant

during such a traumatic time in their lives has to be worth

toxicity decrease (42%; p<0.001). We hypothesised that

pursuing. We believed that If we could achieve this reduction

Mepilex Lite dressings reduced skin reactions by preventing

and validate the data we might then be in a position to

additional mechanical damage (due to friction between

suggest that our solution be used as standard protocol in

damaged skin and clothing or other body parts) and

NZ to prevent radiation induced skin reactions.

chemical injury (due to perspiration trapped in the basal layer) of skin that had already been sublethally damaged by

And globally? Well, there may also be huge implications

radiation, thus allowing for the repair of fragile skin rather

for adopting this same protocol worldwide as it could

than exacerbation of the damage. There were limitations,

positively affect the well-being of hundreds, possibly

however. Firstly, the dressings are not transparent, so

thousands, of women undergoing radiation therapy for

even though we had shown that the dressings had only a

breast cancer each year.

11

The results from this trial (which have been submitted for publication) have exceeded all our expectations, showing a reduction in the severity of skin reactions in excess of 90%. The most significant outcome, however, was that the incidence of moist desquamation. In these patients this With this in mind we started a new clinical trial in late 2012

was 0% which was stunning. For many breast patients

this time using Mepitel Film – a product based on the

moist desquamation is the norm; something to be accepted

same Safetac technology as Mepilex Lite. It is a very thin,

and put up with. The implications of these findings for our

transparent, fully breathable, elastic polyurethane film with

practice are huge. We have found that we can indeed fulfil

a much smaller bolus effect than Mepilex Lite (0.12mm

our overarching aim of finding a treatment that would be

as opposed to 0.5mm). Radiation treatment can be given

superior to the current “standard” of aqueous cream in

through the dressings and skin reactions easily assessed

that it would actually reduce the incidence and extent of

without removing it. Importantly from our perspective, the

radiation-induced moist desquamation in breast cancer

Film conforms to compound curves thus potentially offering

patients. As mentioned earlier, at this point in time radiation

the ultimate in protection to the infra-mammary fold and

induced skin reactions are incredibly common in this patient

axilla – in fact patients have commented that the Film is

cohort. From a patient standpoint, they can be irritating at

so comfortable they forget it is there. This time we wanted

best and seriously debilitating at worst so from a purely

to test the effect of the Film (against aqueous cream)

philanthropic standpoint any new treatment option that has

prophylactically, in other words by using it from the TLDs in

the potential to minimise further distress to women at such a

situ during treatment start of radiation treatment rather than

traumatic time in their lives has to be worth pursuing.

waiting until a reaction in the form of erythema developed.

The treated area was to be divided into a medial half and

We have clearly demonstrated that our patients do not

a lateral half (containing the axilla) which would then be

need to suffer as a result of their treatment. An initial, and

randomised to Film (trial area) or cream (control).

admittedly very rudimentary, cost benefit exercise also indicates that achieving these outcomes does not have to be

It was our intention to test the dressings on a cohort of 20

costly – in fact there is the potential for substantial financial

post-mastectomy patients and 20 patients who had not

savings to be made if we can stop this patient cohort from

had a mastectomy thus allowing us to test the Film in the

developing these reactions in the first place. At last we have

infra-mammary fold and the axilla. Apart from this, we would

the evidence and knowledge that we need for patient care to

closely follow the protocol of our previous two trials to allow

keep pace with the technological advances that have seen

direct comparisons – ie: using the same treatment dose, the

treatment modalities change so radically for the better.

same skin assessment regime and measuring the radiation dose to the skin under all dressings using TLDs. As it turned out, recruitment to the trial was extremely brisk. Patients heard about the trial from other patients who told them how positive an experience taking part was, so new patients would arrive and request to take part! Consequently, we increased the trial numbers from 40 patients to a total of 80 (with ethics’ approval) and still managed to recruit 80 participants and complete the trial inside six months.

12

Radiography machine

13 Radiologists at Dunedin Hospital

Extended Scope Practioner Counties Manukau District Health Board Article by Corey Rosser

T

he goal is simple, reduce waiting lists for those

“The benefits of introducing these roles is manifold. DHB’s

struggling with back pain, and everyone is

are analysed every quarter to review their performance

happy. However, achieving that is the hard part.

against Ministry of Health targets.

Nevertheless, Counties Manukau District Health

Board’s implementation of the Extended Scope Practitioner

To provide increased access to elective services, Consultant

(ESP) role is making some inroads into reducing patient

surgical time needs to be freed up and using physiotherapy

waiting times.

skills provides an alternative but highly skilled and appropriate pathway for patients to access a specialist

The ESP role was first developed in 1987 at Bristol

orthopaedic opinion.

Southmead Hospital in the United Kingdom where it was driven by initiatives to reduce waiting lists, as well

It also increases throughput of patients, decreasing or

as modernisation of medical careers. The role allows for

maintaining outpatient waiting times. It improves working/

physiotherapist-led back clinics to initially assess benign

communication across specialities offering improved

musculoskeletal back pain patients referred by GP’s for

access for GPs.

orthopaedic opinion.

From the surgeons perspective it is enhanced teamwork Studies have indicated that physiotherapists working in ESP

in the management of Orthopaedic patients with improved

roles or in First Specialty Assessor (FSA) led clinic roles are

multidisciplinary working.

effective in reducing orthopaedic waiting lists by managing non-urgent and non-complex cases as first-line practitioners.

Developing these roles also provides a pathway for retention

Research also identifies that very often an ESP can manage

of highly skilled senior physiotherapy clinicians, increased

an entire episode of patient care with accountability to the

liaison with orthopaedic department and increased profile of

lead consultant in that department. As the workload on the

physiotherapy department/expertise within the hospital”

surgeon decreases it allows them to undertake more efficient

From a patients perspective they have an early access to

case-loads and surgical interventions.

specialist skills.”

Counties Manukau District Health Board Senior

Physiotherapy-led back clinics were initially introduced

Physiotherapist Leena Naik explains the significance of the

in Counties Manukau DHB in 2007. The current FSA

ESP and FSA roles to physiotherapy.

role was established in response to a 2012-2013 MOH strategy to improve access to elective surgery, whereby the

14

physiotherapist, as a First Specialty Assessor (FSA), can free up surgeon time to tackle elective surgery lists and reduce waiting times within orthopaedic outpatient clinics.

Within Counties following introduction of these FSA led clinic there was a drop in average wait times from 140 to 123 days. However this is dependent on many variables such as referral patterns. At Counties the wait times for Physiotherapy led clinics is on average 90 days. “If you look at back pain as such, which is what the clinic is more or less about, probably 80 percent of back pain patients can selfmanage their conditions.

“There is probably 1-2 percent who undergo a surgical intervention and 10 percent of patients who actually have any kind of what we call ‘red flags’ or cancerous tumours or infections.”

Senior Physiotherapist Leena Naik

15

Service Focused Straight Up - Young People Talk About Alcohol Project Senior Chef - Cooking Classes for Older People Tracheostomy Review and Management Service Occupational Therapy Role on the Acute Orthopaedic Ward Enhanced Recovery After Surgery (ERAS) in Orthopaedics Pharmacist Prescriber Paediatric Multimedia Project

17

Straight Up Young People Talk About Alcohol Project Whanganui District Health Board Article by Sacha Harwood and Melissa Wishart

A

“shoestring” Whanganui DHB project that aimed at

to resources to support curriculum delivery particularly

giving teenagers informed options and strategies

New Zealand resources. A previous Ease Up on the Drink

around alcohol, actively engaged young people in

initiative delivered in the schools also supported a New

the conception, development and delivery stages

Zealand resource as being more likely to engage students

of the project.

when discussing alcohol.

The Straight Up project developed a teaching resource to

“Ninety five young people were engaged in the project, even

be used in Whanganui secondary schools and alternative

gaining NCEA level 2 credits for their involvement. They

education providers. This was designed to raise youth

interviewed people from the different professions and across

awareness and understanding around alcohol-related harm

the community sector, plus tertiary students from UCOL

and harm minimisation.

(Universal College of Learning) did filming to develop a DVD as part of the teaching resource for schools.”

Mark Wood, Clinical Manager for Child and Adult Mental Health Services says alcohol can be really damaging to

Six posters were produced from the ‘attitude’ segments of

young people, “Young people didn’t seem to understand

the DVD, these were the key messages the young people

they were placing themselves at huge risk. They just didn’t

wanted to share.

have strategies for keeping themselves safe. Yet after viewing the DVD, students had up to 100% increase in

‘Don’t compromise yourself, e hoa ma, you’re all you got.’

knowledge around at risk drinking and keeping themselves

‘Sex is a huge step, don’t let alcohol influence that.’

and their mates safe.”

‘Advertising makes drinking look a lot cooler than it actually is.’

The project is a result of two developments in the

‘You don’t have to get wasted to have a good night.’

community and along with the young people a number

‘Kaua e tukuna ma te waipiro e tukituki ou taonga tuku iho –

of professions within the health sector and across the

Don’t let alcohol destroy your inherited talents.’

community sector were involved. These included the Public

‘He was going on about how smashed he got ... Bro that

Health Centre, Alcohol and Other Drug Services, public

aint cool, that don’t impress me.’

health nurses, teachers and a GP. Those involved from the emergencies services were from the hospital emergency

The young people came up with a whole lot of questions

department, NZ Fire Service, St John Ambulance

they wanted to ask related to alcohol and drinking. Some

and Police.

of it was about confidentiality; some of it was about how the services respond and some of it was about what the

The Public Health Centre in Whanganui conducted

services thought around alcohol. For example, they asked

an alcohol and other drugs needs analysis survey to

Police staff, “If a young person was found drunk and

understand the issues schools were facing. Schools

the Police turned up, what would happen?” They asked

participating in the survey identified a need for access

hospital emergency department (ED) staff, “When someone

18

who is drunk ends up in ED, do they have their stomach pumped?”

“Even them just thinking about the kind of stuff they wanted to talk about, for us, was huge. It’s about a change in attitude, we’ve got to change the way they look at it.”

Mark says there is no point in going on at teens not to drink; rather the project was aimed at informing teens and giving them options and the knowledge to make the right decisions when or if they choose to drink.

On what Mark describes as a “tiny, shoestring of a budget” the project was able to incorporate many different angles and views for young people to think about in relation to alcohol.

“There was a clear message that young people can make a different choice.”

19 Mark Wood, Clinical Manager for Child and Adult Mental Health Services

Elderly citizens in a Senior Chef cooking class

20

Senior Chef Cooking Classes for Older People Canterbury District Health Board Article by Sally Watson

S

enior Chef is a free eight week cooking course which

confidence to cook, cooking skills, fruit and vegetable, milk and milk

provides older people with an opportunity to improve their

product intake and social behaviours higher post course.

nutrition knowledge, cooking skills and to also share meals and socialise in a group setting.

Follow-up evaluation showed these improvements were maintained a year after completion of the course. In addition to quantitative

In 2007/08 dietitians from the Healthy Eating, Healthy Ageing project

evaluation, overwhelming positive feedback from participants was

at the Canterbury District Health Board conducted research on the

received. Common themes included having fun, learning new skills

prevalence of nutrition risk among community-living older people.

and knowledge, increased confidence and enjoyment of socialising.

A sample of 152 people were recruited from medical and falls

The following comment from a 71 year old man was typical. “After

prevention services in Christchurch. As classified by a validated

52 years of having my meals prepared and presented to me by my

nutrition risk screening questionnaire, 31% were found to be at

wife, I suddenly found myself faced with a dilemma that I had not

high risk of poor nutrition. Eating alone and difficulty cooking were

anticipated. Thanks to this course, I now feel that I will be able to

among the common risk factors placing those at risk. To address

look after my nutritional needs with confidence. I hope that those in

these findings, the project dietitians, with funding from the Ministry of

authority will see the enormous benefit of these courses and ensure

Health, developed ‘Senior Chef’.

that they are continued.”

Senior Chef is suitable for older people aged 65 and over (55 and over

Since it was launched, 95 courses have been delivered in Canterbury

for Maori and Pacific people) who live alone or with one other person and

with 940 people graduating from the course. The project dietitians

want to improve their skills, motivation or confidence around cooking.

support graduates to maintain their interest in cooking, eating well

Classes are three hours long and run once a week, starting at 10 am.

and socialising with others by organising regular social events, a

There are usually 10 participants in a course. Each weekly class includes

quarterly newsletter and a Senior Chef website (www.seniorchef.co.nz).

nutrition education, preparing and cooking a meal in pairs, followed by

The website includes information about the course, regional on-line

eating the meal as a group. The nutrition education component covers

enrolment forms, nutrition articles and an extensive recipe section. It

topics relevant to older people and includes eating well, menu planning,

also, includes a members only area for Senior Chef facilitators.

budgeting and shopping tips. The ‘Cooking for Older People’ recipe book, developed by the project dietitians, is used as the main resource.

Due to the success of the courses in Canterbury, Senior Chef has been

It contains easy, healthy recipes that serve one or two people. The

adopted in other regions and to date is available in Southland, Otago,

course is delivered by trained Senior Chef facilitators.

South Canterbury, Marlborough, West Coast, Hawkes Bay and Auckland.

Senior Chef is now well established and the positive health outcomes

After two pilot courses in 2009 showed positive outcomes, Senior

demonstrated in Canterbury shows it is an important community based

Chef was launched in Canterbury in early 2010. Formal evaluation

initiative which can contribute to keeping older New Zealanders healthy

of the first 100 participants attending Senior Chef showed positive

and living in their own homes for as long as possible.

health outcomes. Participants rated their food and nutrition knowledge,

21

Elderly citizens in a Senior Chef cooking class

22

23

Tracheostomy Review and Management Service Capital and Coast District Health Board Article by Kerry Huggins and Molly Kallesen

T

he Tracheostomy Review and Management

in process and some concerning examples of poor

Service (TRAMS) is an interdisciplinary

tracheostomy management which created significant risk for

team that provides advice and management

patients. In addition, the team became aware of deaths in

for hospital patients with percutaneous

the region due to tracheostomy mismanagement and were

tracheostomy tubes after they have left the

keen to prevent this at CCDHB. In addition, the TRAMS

Intensive Care Unit (ICU). The team includes speech-

project group conducted a survey of doctors, nurses and

language therapists (SLT), physiotherapists, nursing and

allied health professionals across the hospital.

intensivists. Each team member contributes to decisions around the weaning and removal of tracheostomy tubes

Results indicated that most staff saw very few patients with

(referred to as decannulation).

tracheostomy (one or fewer per year) and many staff expressed low confidence in managing patients with tracheostomy.

In 2008, a Speech Language Therapist attended a workshop at the New Zealand Speech-Language Therapy Association

The TRAMS project group felt patients with tracheostomy

conference in Auckland by an SLT, physiotherapist

would receive a much better and safer service if there were an

and nurse from the TRAMS service at Austin Health in

interdisciplinary service to provide education and support to

Melbourne, Australia. Austin Health was the first hospital

nurses caring for patients with tracheostomies; a very similar

to develop and document an interdisciplinary model to

model to Austin Health. The CCDHB approach is unique

maximise safety and education regarding tracheostomy

because it is led by the ICU team. This means that the same

management. This proactive approach resonated with the

doctors who insert the tracheostomy follow the patient and

SLT and her Allied Health colleagues as they had often

manage the tracheostomy until it is eventual removal.

been frustrated by delayed and risky decision making regarding ward tracheostomies and the lack of delineation of

The project group collaborated closely with ICU staff, ward

responsibility, which led to increased risk to the patient and

staff and allied health to develop the Tracheostomy Review

cost of care. The C&CDHB SLT approached ICU to see if

and Management Service (TRAMS) Policy. The TRAMS

such a model would be possible at our hospital. In 2009, an

team was officially launched in April 2011. Since then, every

ICU intensivist, nurse and SLT visited TRAMS in Melbourne

patient with a percutaneous tracheostomy discharged from

in 2009. This visit energised the team and was the catalyst

ICU to a hospital ward has been followed by the TRAMS

for the project moving forward.

until decannulation or hospital discharge.

During the same period, the SLT conducted an audit of

The ICU consultants report that they feel safer discharging

all patients discharged from ICU to hospital wards over

patients to the ward, knowing that they will be well cared

a two year period. The audit reflected the slow decision

for. This increases flow through ICU, increasing capacity

making that clinicians had noticed, the lack of consistency

for admissions. Also, Allied Health staff has observed that

24

decannulations are happening quicker and decision making

removed. Over the course of a few weeks the TRAMS team

about tracheostomy weaning and decannulation is more

implemented an aggressive weaning plan and the woman

transparent and collaborative. Ward patients have clearly

was decannulated before discharge from hospital. Removal

documented plans facilitating more consistent care.

of the tracheostomy meant the young woman was able to return home to the care of her family rather than a facility.

The following patient examples demonstrate the benefit

These case examples demonstrate that the TRAMS has

of TRAMS. The first patient, a 50yr old woman, was due

provided a safer environment for this group of vulnerable

for a tracheostomy change after 30 days. As per the

patients and provided support to ward staff when dealing

TRAMS policy, the ICU doctor performed the change with

with an often unfamiliar situation. There have been no

assistance from other TRAMS members. On removing the

unplanned readmissions due to tracheostomy related

old tube some granulation tissue was disturbed and the

issues and no tracheostomy related deaths or near misses.

patient started to bleed quite heavily. This complication was

Quicker, safer decannulation is better for the patient, can

completely unexpected and the patient required the expert

reduce bed days and reduces cost of care.

care that the ICU Doctor and TRAMS team initiated and urgent input from ENT to stop the bleeding. Previously, this

The TRAMS is now well embedded in clinical practice.

incident could have escalated to a point where the patient

In the future we would like to role the service out to the

deteriorated and collapsed resulting in serious harm. The

community and increase our role in education. Ideally, we

presence of expert help ensured that the patient received

could provide consultation and education as needed to

the appropriate care in a timely fashion.

practitioners throughout our region.

The second patient was a young woman with a severe brain

TRAMS succeeded because of the hard work and

injury following a car accident. At the time of her accident

dedication of a range of professionals. In particular we

she had a very low cognitive function and a tracheostomy

would like to acknowledge the following team members:

was placed to assist with breathing and clearance of

•

Thomas Andrews, ICU Clinical Nurse Specialist

secretions. She was discharged to a brain injury facility with

•

Dr. Alex Psirides, Intensivist

her tracheostomy in place and the family was told it would

•

Naomi Seow, SLT

likely be permanent. Six months after her accident she was

•

Dr. Shawn Sturland, Intensivist

re-admitted to hospital with feeding tube complications.

•

Jenny Hill, Patient at Risk (PAR) CNS

The SLT noted her cognitive function had improved slightly and she consulted the TRAMS team. The young woman’s family was very keen to have the tracheostomy

25 Doctors observing a patient in Wellington Hospital

Doctors observing a patient in Wellington Hospital

26

â&#x20AC;&#x153;

The ICU consultants report that they feel safer discharging patients to the ward, knowing that they will be well cared for.

27

â&#x20AC;?

Occupational Therapy Role on the Acute Orthopaedic Ward Capital and Coast District Health Board Article by Jess Thompson

A

cross New Zealand hospitals, the Occupational

This, therefore, led to three themes for process

Therapist (OT) role on the Orthopaedic ward is

improvements: 1. Utilisation of Therapy Assistant role

well established with a significant resourcing of occupational therapy time being dedicated

• Tasks appropriate for delegation to a suitably trained

to elective (mainly hip and knee replacements) and trauma

Therapy Assistant (TA) were identified in consultation

patients.

with the OT Professional Leader.

• The TA’s competencies were developed further and the

There have been thoughts amongst many Occupational

TA was then trained in the required skills.

Therapists in the acute setting that this current provision

• Guidelines were developed regarding the TA role on the

of care does not need to be delivered by a trained

orthopaedic ward.

Occupational Therapist, though while this thinking has been 2. Occupational Therapist’s role

ongoing changes in practice have not been evident.

• Education was provided to the orthopaedic In line with this thinking, the new senior Orthopaedic

multidisciplinary team regarding clarification of

Occupational Therapist at Capital & Coast District Health

essential OT input & TA use with this client group.

Board (CCDHB) felt that overprovision of OT input was

• Development of a clinical care pathway for OT and TA

embedded in ward processes. There were expectations on

involvement post hip and knee surgery.

the orthopaedic ward for daily OT input with all patients and

• Development & implementation of a specific

there was little defined or regular utilisation of the Therapy

assessment form targeting single intervention patients.

Assistant (TA) on the Orthopaedic ward. As a result of this 3. Ward processes & resources

and through the statistical review of health roundtable data (hospital data collated from a range of Australian &

• Created new working processes and resources in

NZ hospitals) it showed that CCDHB was providing above

order to increase the efficiency of OT input provided

average input to the Orthopaedic Diagnostic Read Codes.

on the Orthopaedic wards, both to trauma and elective

It was identified that by meeting average input significant

diagnostic read groups.

therapist time could be saved.

28

Occupational therapist showing a range of equipment made to help patients

29

Occupational therapist showing a range of equipment made to help patients.

30

Firstly, a review of OT and TA statistics from January – April 2012 (prior to implementation) with a comparison made to November – February 2013 (after implementation).

This demonstrated TA input had increased with all DRG categories, though most significantly with hip conditions, while OT input with all DRG categories had decreased and overall total time had decreased. This change occurred while the quality of care was not impacted negatively.

Secondly review of OT clinical requirements December – March 2013 This showed the OT consistently finished their caseload after six hours vs. eight hours (as per before implementation) This change aligned with the Institute for Healthcare Improvement (IHI) Triple Aim principles as identified below: • Improving the experience of patient care, including quality and satisfaction.

• Clear and transparent processes were developed for patient assessment and treatment, which were provided through efficient & timely use of resources with intervention targeted at patient need. This was consistent with evidence based practice and was provided through quality assessment and treatment.

This was evidenced through; • Utilisation of the TA role where OT was not required allowing OT resources to be redirected to patients requiring OT skills.Development of clear guidelines for staff around expected input with specific patient groups ensuring consistent input from OT team and ensuring appropriate care is provided.

• Increased time for senior OT to mentor and up skill other team members, leading to improved patient care.

Reducing the per capita cost of health care: • Reduction in resources from OT – evident by OT seeing less Orthopaedic patients and the time taken to see patients reducing, while the provision of quality care has been retained by the use of TAs.

31

Enhanced Recovery After Surgery (ERAS) in Orthopaedics Taranaki District Health Board Article by Greg Sheffield

A

Taranaki project aimed at helping patients recover

help identify patients with comorbidities (e.g. anaemia,

more quickly after knee and hip surgery has proven

poorly controlled diabetes, hypo/hypertension) and

a great success, with the average length of stay

instigate timely and appropriate onward referral

reduced by 30 percent. Enhanced recovery after

• Consistent education regarding alcohol and smoking

surgery (ERAS) is designed to prepare patients

cessation

for, and minimise the total impact of, surgery by helping

• An Allied Health screening tool. This helped to identify

them to recover more quickly. It does this by applying an

patients that would benefit from allied health input such

evidenced-based approach to care. ERAS aims to optimise

as dietician input to manage malnutrition, physiotherapy

patient outcomes by the aggregation of marginal gains.

to regain function, or occupational therapy to advise on and provide home equipment

A working group was set up in July 2012 to look at the

• A RAPT (risk assessment and predictor tool) score – this

potential for ERAS principles to be applied to patients

is a tool that scores patients social factors to predict

undergoing primary total hip replacements (THR) and total

whether they are likely to have an extended length of

knee replacements (TKR) at Taranaki District Health Board

stay. This was used to focus and prepare services for

(TDHB).

those patients that were most likely to benefit.

An initial review of our pathways identified several factors to

• A comprehensive, anaesthetist-led, pre-operative

work on:

assessment aimed to provide clear and consistent

• Elective THR and TKR were our single biggest pathway

information to the patient to help reduce any anxiety by

• Our average length of stay was 6.72 days

involving them in the decision making processes

• Multiple pathways for different orthopaedic surgeons

• A pre-operative education class, for patients, two weeks

• The lack of a structured joint replacement pathway

prior to surgery – detailing the patient journey through

across all specialties

hospital and once back at home following surgery

• Obtaining a better understanding of inpatient costs in

• Providing a carbohydrate drink two hours before

an increasingly challenging fiscal climate

surgery to minimise dehydration and the stress

• Most importantly, improving patient experience and

response of surgery.

clinical outcomes Intra-operative Having identified our challenges, the working group set

• Default regional anaesthesia +/- sedation

about reviewing the latest literature and evidence from

• Standardised analgesic pathway

within New Zealand and overseas. As a result of this, we

• Minimising blood loss through the use of tranexamic

made a series of changes to our patient pathways – through

acid and avoidance of surgical drains

pre-operative, intra-operative and post-operative phases.

• Standardised prosthesis Post-operative

The key changes introduced were: Pre-operative

• Promotion of patient independence throughout the

• A nurse-led triage service five months prior to surgery.

whole process

This included robust screening and laboratory testing to

• Early oral hydration and nutrition

32

• Regular oral analgesia

Greg Sheffield, the ERAS project manager, stated the most

• Early removal of catheters and IV lines

important outcomes were, “bringing in a patient education

• Planned early and regular physiotherapy

class about two weeks before the patient comes in. We

• Early return home

talk them through exactly what’s going to happen – what’s

• Strong ties to on-going rehabilitation in the community

going to happen in theatre, what’s going to happen after surgery, what to do before surgery, how to prepare, how

Managerial

to prepare their home for after surgery so they’ve got

• A standardised multidisciplinary protocol

everything ready. It’s particularly important to make sure the

• Re-developed critical pathway documents

home is ready.”

• New patient information booklets • Pre-printed medication charts

“Patients felt fully informed and well prepared for all aspects

• Analgesic pathway posters

of their surgery.”

The changes were trialled with one orthopaedic surgeon in

“We used to be the worst DHB in New Zealand for our

January 2013, following positive feedback and improved

length of stay. I’m confident we will be one of the better

outcomes for the patients the changes were then rolled out

performing DHBs now.”

to the remaining orthopaedic departments in August 2013.

Having implemented this raft of changes the overarching

“The project is a great example of how well multidisciplinary

achievements were:

teams can work alongside one another and most specifically

• High degrees of patient satisfaction

the importance of the many allied health, scientific and

• A reduced average length of stay from 6.72 days to

technical roles within these teams.”

4.30 days In October 2013, a national collaborative for Orthopaedic

• The average cost per patient reduced by 12%, a saving

ERAS was launched by the New Zealand Ministry of Health,

of approximately $2,500 per patient • Lower re-admission and complication rates

with a view to rolling out ERAS nationally by January 2015.

• Improved DOSA (day of surgery admission) rates

We look forward to continuing our work on this project, and hope to achieve further successes yet.

33

Greg Sheffield, ERAS project manager

Pharmacist Prescriber Counties Manukau District Health Board Article by Gemma Stanbridge

F

ollowing changes to the law and the initial

reasoning skills. Over these hours the pharmacist and

innovation pilot for pharmacist prescribing in

medical practitioner supervisor collect evidence to show

New Zealand, Middlemore Pharmacy Services

the Pharmacist has achieved the competencies required to

manager Sanjoy Nand initiated the feasibility

collaboratively prescribe within their specialist area. After

of pharmacists prescribing drugs in particular areas of

the supervisor has signed off on the supervised hours and

competence at Middlemore Hospital.

the pharmacist has completed the assessments required by the postgraduate course, the pharmacist may apply

Changes to the Medicines Act 1981 and the Misuse of

to register as a pharmacist prescriber with the Pharmacy

Drugs Act 1975 allow clinical pharmacists who have

Council of New Zealand.

demonstrated competence to prescribe medicines in a specific area. The feasibility project focused on pharmacy

The monetary cost of training to be a pharmacist prescriber

prescribing in a hospital and outpatient setting and was run

is around $4000 for a postgraduate qualification. However,

in 2013.

most of the cost is in time at the hospital for the supervision requirement hours, but this can be offset by the benefits a

“The first cohort in 2012 were the pioneers. That pilot

pharmacist prescriber makes to the system and patient care.

was run to enable the decision of whether it was a good

Ms Kam said postgraduate study is encouraged, but is

idea or not,” Mr Nand said. A clinical pharmacist training

not an easy undertaking, but the qualification is a point of

to be a pharmacist prescriber chooses a specific area to

difference that shows a pharmacist possesses competency

demonstrate prescribing competence in.

in a certain area.

Middlemore Renal Services clinical pharmacist Angela

“It shows you are competent and can provide something

Kam took on the opportunity to train as the first pharmacist

above and beyond,” she says.

prescriber at Counties Manukau Health.

“It makes the job a lot more varied; there are more “Choosing to work in a certain specialty does not

opportunities, more options.”

limit opportunities for pharmacists, ,” Ms Kam says.

“Pharmacists are still able to branch out and expand their

The innovation pilot saw 14 clinical pharmacists nationwide

knowledge and skills even further.”

complete the one-year Postgraduate Certificate in Pharmacy Prescribing at either the University of Auckland or the

Pharmacists interested in upgrading their skills are required

University of Otago in the first year (2012).

to find a dedicated medical practitioner who will supervise them for 150 hours. The supervised hours include patient

Mr Nand said traditionally the pharmacists work as advisors

consultations, and interactions to demonstrate therapeutic

while doctors do most of the prescribing. Now pharmacist

34

prescribers, with the level of experience and knowledge

Ms Kam says she works in a multidisciplinary and

along with the postgraduate certificate in prescribing, can

collaborative environment and part of her training

also prescribe, but only in their area of competence.

includes observing consultant clinics. She works with the doctors and nurses at the hospital to develop lines of

Mr Nand said pharmacist prescribing is important because

communication, following up on blood tests, and

it makes for efficient decision making especially when

providing advice.

resources are stretched.

Ms Kam said the role of a pharmacist is traditionally “Doctors and pharmacists can work in a better collaborative

thought of as counting pills. “It’s totally different now. The

environment with trust and understanding. There is better

opportunities for career progression makes pharmacy a

discussion and agreement, and better, more informed,

more attractive option for students. The programme sets the

decisions can be made which is always better for the

way for junior pharmacists,” she said. Mr Nand agrees.

patients,” he says.

“There is better career progression, autonomy, increased job Ms Kam follows up on renal patients on a weekly or

satisfaction and remuneration, and it enables competition in

fortnightly basis in an outpatient setting, monitoring the

the global market,” he says.

effects and benefits of medication decisions and developing a relationship with her clients.

Angela Kam - Pharmacist Prescriber

35

Paediatric Multimedia Project Canterbury District Health Board Article by Kate Parker

iPod in use

Kate Parker, creator of multimedia project

R

adiotherapy is an important treatment used to help cancer

iPods. This has enabled the department to buy iPods and an extensive

patients of all ages. It is a targeted treatment which requires a

iTunes library, so children have a large variety of movies to choose from.

high level of precision and because of this patients must stay

The use of this multimedia has made treatment for many children more

extremely still during treatment. A full treatment course can

accurate and less stressful.

be up to 30 visits over six weeks. They can also last for up to

half an hour per visit so this can be a very difficult. Now imagine asking an

The second part of the multimedia project was the development of

eight year old to do this.

treatment movies for the child. This is a documented journey of the childâ&#x20AC;&#x2122;s treatment but is done in a fun way. They can be used by the child

If a child in unable to stay still for treatment they require a general

to remember what happened to them later in life or as a teaching tool for

anaesthetic. This can be very distressing for the child and their family not

friends and family. These movies were made possible by donations of a

to mention extremely resource intensive. The average cost of a general

MacBook Pro and editing software from the Child Cancer Foundation.

anaesthetic is $1000 per procedure.

Post-production editing is currently being done for free by a kind graphic designer. Since the start of this project ten treatment movies have been

A paediatric team was established in order to investigate ways to make

made for the children.

radiation treatment easier and less traumatic for children in Christchurch Hospital. The aim was to make treatment as enjoyable as possible and

The department has had a lot of positive feedback from patients, their

be remembered as a positive experience. Visiting the Peter MacCallum

family and other staff involved in the wider treatment of the child. The use

Cancer Centre in Australia and liaising with other centres in the UK lead to

of multimedia in this department could possibly be used as a template for

establishing the multimedia project. This involves using multimedia on an

other departments in the hospital. We are also looking at extending the

iPod as a distraction tool for children.

project to be used for young adults. Cancer diagnosis and treatment can be a stressful time for all involved and the oncology department aims to

In order to do this, a special viewing mount had to be constructed that

make this experience as pleasant as possible for everyone involved.

attached to the treatment couch. It needed to be able to be positioned out of the way of the radiation beam but allow the child to watch it at the same time. The team in the Medical Physics Department were able to develop a state of the art mount using an iPhone car-kit, a stereoscopic arm used for patients in wheelchairs and an industrial clamp gentle enough to not damage the carbon fibre treatment bed.

Over $3000 of donations has been raised through staff fundraising events and from individual donations in the form of iTunes vouchers and pre-loved

37

38

Radiation Machine

â&#x20AC;&#x153;

If a child in unable to stay still for treatment they require a general anaesthetic. This can be very distressing for the child and their family not to mention extremely resource intensive.

â&#x20AC;?

39

Education Focus

Allied Health Technical and Scientific Educator Sonography Training

41

Allied Health Technical and Scientific Educator Capital and Coast District Health Board Article by Suzanne Stubbs

A

llied Health, Technical & Scientific (AHT&S)

in a sub-regional model, however it is recognized that there

encompasses over 30 different professions.

are instances where a DHB has a training requirement that

Although the educator role is an established

others do not have, therefore flexibility is key. An increase

role within the nursing and midwifery

in access to learning and development for the AHT&S

professions it is a new role for AHT&S, and

professionals enables workforce development and supports

this is the first of its kind in New Zealand.

provision of a quality service for patients.

The joint funding and support for this role as a three

Key areas identified for the role to initially focus on were:

DHB position is also one of the first sub-regional roles

• Objective Setting & Portfolio Development Training

within AHT&S.

• Clinical Goal Setting Training • Clinical Effectiveness Training (i.e. Change

As a result of more joined up working throughout the

Management, Clinical Audit, Research Skills, Project

AHT&S professions and within management structures of

Management)

the three DHBs it was identified that there were a number of commonalities within the workforce with regards to their

This has since progressed to include the following:

learning needs. There are generic and shared needs within

• NZQA Training for Allied Health (Dental & Rehab) Assistants

professions, across sites and also common learning needs

• Coordination of the AHT&S Seminar Series (in

across the AHT&S professions.

conjunction with the University of Otago) • Career and Salary Progression (CASP) training

Prior to the development of the AHT&S educator role, training and education was managed by individual teams and managers. This led to fragmented and inconsistent provision of training, duplication of work or more

“An increase in access to learning and development for the AHT&S professionals enables workforce development and supports provision of a quality service for patients.”

commonly no training or

• Analysis of the need for Preceptor training • Analysis of Supervision training across all three DHBs and developing a sub-regional training framework An example of one of the training initiatives led by the Allied Health,

development opportunities for some professional groups or

Technical and Scientific Educator is the roll out of the allied

in certain areas of learning need.

and public health CASP training.

The mandate of the AHT&S educator role is to coordinate,

This training package was developed to support a regional

support and evaluate core training required by the AHT&S

project, which aimed to align the way the CASP process

professional groups and the DHBs. Where a three DHB

was delivered across DHBs and services.

approach can be taken training is developed and delivered

42

Suzanne Stubbs

43

The need for training of staff and managers on the new

we are in a strong position to foster and grow this through

process was identified by the project group; this was then

the educator role, which is focussed on educational

passed on to the educator who was able to work with the

opportunities across professional groups.

project team to develop a training package. This included trainer notes and presentation, learning resources and

Christine King, Associate Director, Allied Health,

an evaluation plan which could be rolled out across the

Technical & Scientific, CCDHB

region using a train the trainer approach. The evaluations were designed to evaluate the new process as well as the As an Allied Health Professional Leader and Manager I have

training, so are able to feedback into the project team.

found the establishment of the Allied Health educator role very beneficial.

Using such an approach ensures consistency of messaging and saved duplication of work for each DHB developing

Prior to the role being in place the emphasis was on managers

individual training.

to provide training on the CASP framework and processes.

Feedback from those involved The Allied Health, Technical & Scientific Educator role has

It’s my observation that the development and

been pivotal in the central region roll out of consistent

implementation of training for CASP as well as therapy

processes for CASP.

assistant training and supervision training of which has been led by the Allied Health Educator has provided support to

The educator role has supported the working party by putting

leaders and managers that has supported ongoing education

the newly developed ‘consistent’ processes into action

and development of their staff.

through the development of our new look training, of which is Sue Doesburg, 2DHB Professional Leader –

being delivered in line with educational delivery best practice.

Physiotherapy, Hutt Valley and Wairarapa DHBs This role provides the expertise in the delivery of education and evaluation specific to our professions that we have not

The AHT&S educator and the sub-regional AH leadership

had access to or support for previously and it is evident

have an on-going shared dialogue regarding current and

with this role now in place that we were previously missing

future projects. This ensures alignment with the strategic

access to a very valuable role.

direction of the AHT&S leadership, DHBs goals and ensures accountability.

The educator role has also reinforced the many aspects of training that are consistent and can be shared across

This role has ready access to experts in the learning and

different professions and in this period where inter-

development field, an education technology advisor and

professional training is becoming increasingly recognised

media developer, as well as administrative support.

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Workbook to help students

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Sonography Training Counties Manukau District Health Board Article by Gemma Stanbridge

T

he Counties Manukau and other Northern Region

The Sonographer Workforce Project began in September

DHBs (Northland DHB, Waitemata DHB, Auckland

2012 and involved the Northern Region District Health

DHB) have launched a new collaboration with the

Boards, private practices, and the University of Auckland

private and university sectors to train sonographers.

who have recently established the Postgraduate Diploma in Health Science in Ultrasound (PGDipHSc).

At present there is a sonographer shortage. This affects not only the workload and morale of many who work in under-

Initiated by Mr Hewitt, and the Northern Regional Radiology

staffed ultrasound departments but also patients on waiting

Network, the project brought these groups together because

lists and hospital bed space. The most significant person

the long-standing problem of a qualified sonographer

affected by this is the patient.

shortage affects most of the wider Auckland region.

Middlemore Radiology Services manager Paul Hewitt said

Middlemore Ultrasound team leader Ms Azile Hooper said

wait times for an ultrasound scan, for patients in hospital,

there were plenty of people wanting to learn ultrasound, but

can be up to three days when departments were under-

there was a bottle neck in clinical placements.

staffed, compared to same-day scanning when fully staffed.

Currently the New Zealand radiology professional body says There can be lengthy waiting times for patients needing

a trainee must complete 2000 supervised hours to become

routine ultrasound scans, if referred from a clinic or from

a qualified sonographer.

the family doctor. Some smaller hospitals have to fly sonographers in on weekends.

“You cannot learn ultrasound by watching someone scan, you need to do it yourself. It’s my hand on the student’s

By the time you get to the scan you could be in a clinically

hand showing them how to work the probe.”

worse situation, Mr Hewitt said.

“Traditionally we’ve only had three students at one time,” Adding to this is that demand for ultrasound has increased

Ms Hooper said.

substantially over the years and sonographers now perform a much broader range of examinations.

Providing this supervision for sonographer trainees, is a huge commitment for any healthcare provider as the institution’s

Ms Hooper says, “We used to only do abdominal, pelvic,

workload has to be slowed down to allow the trainees hands-

obstetric and ‘small parts’ such as thyroid and scrotum

on training time which in turn affects patient waiting times.

scans. Now we scan tendons, muscles, blood vessels, heart and eyes.”

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The Sonography workforce project is looking at alternative

Ms Hooper said this collaboration in itself should generate

training and clinical placement models in a unified way across

more clinical placements for trainees in both the public and

the public and private sector. It was recognised being creative

private sector. This part of the project has progressed well

was important, said Ms Hooper, and that doing the same as

and looks promising to start in 2014.

they had in the past, was not an option.

The project’s overall aim is to gain an accurate assessment The project group decided two goals needed to be pursued.

of sonographers needing to be trained and not to have a

The first was an investigation of the options to generate

‘knee-jerk’ reaction to sonographer shortages. With the next

additional resourced, clinical placements in the region. This

step being to collaboratively increase the number of trainee

investigation produced detailed data for the region on the

positions for the region and nation, as well as having a

number of patients scanned, the growing and changing

collaborative approach to the training.

population demographic, and the anticipated number of sonographers required for the current and future population.

Mr Hewitt said the project had been welcomed and it was

The second goal was to investigate the feasibility of

successful in bringing both public and private radiology

implementing a 12 to 14 week intensive training course for

providers together, which is a great outcome.

trainee sonographers.

One of the challenges, Mr Hewitt notes, is changing the length of time to qualify. “It’s a journey of changing hearts

This would involve a collaboration of both public and private

and minds.”

sectors along with Auckland University. This course was a significant development as it took the very intensive oneon-one initial training away from the ultrasound providers so that patient waiting times would not be adversely affected by taking on new trainees.

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